Provider Demographics
NPI:1770823015
Name:VANCE, MATTHEW P (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:P
Last Name:VANCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 WELLINGTON TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8345
Mailing Address - Country:US
Mailing Address - Phone:314-488-0876
Mailing Address - Fax:
Practice Address - Street 1:4600 N HANLEY RD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2715
Practice Address - Country:US
Practice Address - Phone:866-997-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009031401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist